System Design for
The Bill & Melinda Gates Foundation
Design Institute for Health
Gwen Gage, Caroline Garry, Taylor Cook, Caroline Kusi, Stephanie Morgan, Lauren Gardner, Stacey Chang.
The Bill & Melinda Gates Foundation provides more than a billion dollars in funding for global health intervention campaigns aimed at managing infectious diseases. These campaigns are planned and delivered by a vast ecosystem of global organizations and country-level partners.The current situation results in the delivery of these health interventions being highly fragmented and leading to missed opportunities for efficiency gains and the ability to share best practice across global and country-level partners.
The Grand Goal
This Systems Design for Campaign Effectiveness work-stream, was part of the broader Systems Design for Global Health effort by the Gates Foundation including project partners: The Task Force for Global Health, Linksbridge, R4D. Each project partner had their own scope but contributed towards the launch of the Health Campaign Effectiveness Coalition.
Our team at the Design Institute for Health was brought on to:
• Understand how various tangible and intangible factors can impact effectiveness and drive behavior throughout the system.
• Identify and investigate collisions and points of friction between stakeholders.
Surfacing System Dynamics
The first phase focused on understanding the ecosystem of 10 of the biggest health intervention campaigns done annually. By mapping the global landscape for each health intervention and analyzing the relationships and exchanges between the key actors in the ecosystem we were able to start noticing interesting system feedback loops. The early patterns that we uncovered in this phase helped illuminate areas for further systemic inquiry in the next phase of the project.
Compare a high-capacity and a low-capacity country context.
We chose Ghana as a representative of a high-capacity of & Liberia as a representative of a low-capacity
Focus on one immunization and one NTD campaign present in all focus countries.
We chose Schistosomiasis as a representative of NTDs & Polio representative of immunizations.
Throughout this phase we interviewed 88 subject matter experts and engaged stakeholders across different levels of the system.
Juxtapozing Different Contexts
We analyzed and compared the Stakeholder Landscapes and Annual Campaign Process Cycles across Ghana and Liberia
for both Schistosomiasis and Polio. These system maps that we created became one of our key deliverables, a tool for alignment during stakeholder convening and campaign planning.
Schistosomiasis was my main disease of focus
Polio was the main focus of my team mate Gwen Gage
We also created a revised global ecosystem map for Schistosomiasis and Polio showing the various value exchanges of the global health organizations involved in these disease campaigns.
Planning & Launching a Global Coalition
Our team contributed to the grander goal of the Health Campaign Effectiveness Coalition in 3 ways:
We helped our partner The Task Force for Global Health plan and strategize the learning cycles of The Health Campaign Effectiveness Coalition.
We helped facilitate the inaugural launch event of the coalition, a 2 day virtual gathering with over a 100 participants from around the world.
We presented some of the findings from our systems research from Ghana and Liberia during the inaugural event.
The Final Systemic Insights
Community-level factors are not shaping approaches, but they are shaping outcomes. To improve effectiveness, campaigns must make community-level factors a core component of future strategies.
Global organizations aim for equal partnership with countries, but some of their actions are misaligned with that goal. If responsibility, power, and resources are not actively shifted to the country, country ownership will be impossible to achieve.
Global organizations’ efforts are continually undermined by their own cautious mindsets and rigid accountability mechanisms.
Having a strategy to identify and address unproductive organizational mindsets is essential to making room for innovation in campaign design.
A metaphorical model to help explain the 3 systemic insights.
These insights point to several opportunity areas that the global health stakeholders can pursue to catalyze systemic change towards a more coordinated and effective campaign ecosystem.